A state of complete physical, mental and social well being, not merely the absence of disease or infirmity.

(WHO)

Income and social status Education Physical environment Employment and working condition Social support network Culture- customs, traditions, beliefs Genetics Personal behaviour and coping skills Health services Gender

The science and art of preventing disease, prolonging life, promoting health and efficiency through organized community effort for the sanitation of the environment, control of communicable diseases, the education of individuals in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity

A special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health programme for the promotion of health and improvement of the conditions in the social and physical environment, rehabilitation of illness and disability( World Health Organization Expert Committee of Nursing).

Community health nursing is one of the two major fields of nursing in the Philippines; the other is Hospital nursing. 1. Community Health Nurse

Occupational health nurses, school health nurses

2. Public Health Nurse

Those who work in Rural Health Units (RHUs) or health centers

What is the essence and nature of community health nursing? American Nurses Association

CHNsg practice promotes and preserves the health of

populations by integrating the knowledge relevant to both nursing and public health The practice is comprehensive and general, and is not limited to episodic care

Clark
While community health nursing practice includes

nursing directed to individuals, families and groups, the dominant responsibility is to the population of the whole.

1. The goal of professional practice is the promotion and preservation f the health of populations 2. The nature of practice is comprehensive, general, continual, not episodic 3. The knowledge base comes from nursing and public health

4. The different levels of clienteleindividuals, families and groups 5. The practitioners recognition of the primacy of the population as a whole

The hallmark of community health nursing is that it is population- or aggregate focused.

Greater control for both the nurse and the client in making decisions related to health care Collaboration between nurse and client as equals Recognition of the impact of different factors on health Nurses greater awareness of their clients lives and situation
CHNsg has greater perspective than institutional or

hospital nursing

1. Emphasis on the importance of the greatest good for the greatest number 2. Assessing health needs planning, implementing and evaluating the impact of health services on population groups 3. Priority of health-promotive and disease preventive strategies over curative interventions

4. Tools for measuring and analyzing community health problems; and 5. Application of principles of management and organization in the delivery of health services to the community

1. The family is the unit of care; the community is the patient and there are four levels of clientele in community health nursing. 2. The goal of improving community health is realized through multidisciplinary effort. 3. The community health nurse works with and not for the individual patient, family, group or community. The latter are active partners, not passive recipients of care.

4. The practice of community health nursing is affected by changes in society in general and by developments in the health field in particular. 5. Community health nursing is part of the community health system, which in turn is part of the larger human services system.

Three major concepts

Community (Client) Health (Goal) Nursing( the Means)
Health is a basic human right The Universal Declaration o Human Rights Article 25, section 1 states that: Everyone has the right to a standard living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

1. Individual

These are the people who consult at the health center and receive health services Considered the entry point in working with whole family Performs two major functions: reproduction and socialization Considered as the basic unit of care in CHNsg Contribute to the development of health and nursing problems to its members Performs health-promoting, health-maintaining and disease preventing activities. Source of solid support and care to its members

2. Family

3. Population group/Aggregate
A group of people who share common characteristics, developmental stage or common exposure to particular environmental factors and consequently common health problems. E.g. children, men, women, farmers, military, prisoners, etc.

4. Community
A group of people sharing common geographic

boundaries and/or common values and interests. No two communities are alike Characteristics:
1. Defined by its geographic boundaries w/in certain identifiable characteristics 2. Made up of institutions organized into a social system linked in a complex network having a formal and informal power structure and communication system 3. A common or shared interest that binds the members together exists 4. It has an area of fluid boundaries within which problem can be identified and solved 5. It has a population aggregate concept

The PHN can only perform his/her functions effectively if he/she:

a) Has the necessary knowledge, skills and attitudes

in dealing with the health needs and problems of the client b) Is familiar with the structure and dynamics of the health care system and its broader sociocultural, economic and political context c) Is knowledgeable of laws and policies affecting the health care system in general and nursing practice in particular and of nursing and program standards. RA 9173(Philippine Nursing Act of 2002)

Occupational Health Nurse (OHN)

As formulate by the Occupational health Nurses Association of the Philippines (OHNAP) 1. Curative/palliative 2. Preventive 3. Educative 4. administrative

Major areas of concern

1. 2. 3. 4. 5. 6. 7. 8. 9.

Emergency and palliative care Family planning Counselling Immunization Environmental sanitation Work safety Disaster prevention and control Orientation of new employees Dissemination of health information/health education

Administrative Functions

Plan, recommend, and/or implement medical service programs for the benefit of employees and managers Create awareness among nursing/paramedical staff on proper budget control Refer to the company physician problems/cases for disposition and management Supervise nursing personnel and/or paramedical staff Encourage professional development amonfgnursing and paramedical staff

Administrative Functions
Coordinate medical services program with other

departments and other community and government agencies Assess occupational health problems in the company with emphasis on preventive aspects such as recognizing existing and potential hazard Plan/prepare/monitor the use of the medical service manual Maintain individual records and ensuring their confidentiality Conduct research on concerns affecting working conditions

Administrative Functions
Recommend practical techniques, methods,

systems and approaches regarding health and safety Participate in the promotion of family planning and submit FP report to the DOLE Family Planning Unit Prepare and submit report on medical/hospital cases, accidents utilization of medicines Facilitate the referral of employees and/or their relatives to government/private agencies Evaluate the medical service program in terms of effectiveness and relevance

Activities are focused on:

Health promotion Disease prevention and early detection of disease Emergency care Referral to higher level health facilities

Manages the school clinic

Performs:
Health assessment Screening

Case-finding
Health education Nursing procedures

Varies from one community to another, municipalities and cities have different levels of capability Roles and functions
1. 2. 3. 4. 5. 6. 7. 8.

Manager Planner Implementer Monitor Evaluator Educator Facilitator Coordinator

The practice of a profession is guided by a number of legal and ethical principles that are primarily centered on the welfare of clients and protection of their rights. Professional practice is legal if the practitioner works in accordance with the law or does not violate its provisions

1.
2.

3.

Respect for autonomy Beneficence Justice

All of these form the bases of the clients rights in

health care setting Distributive justice- fair, equitable and appropriate distribution Equity rule- scarce resources should be given to the one who is in greater need PHNs do not only deliver needed health services, they also humanize the health care delivery system as well

Right to be informed about his/her condition- adequate and accurate information Right to safe and quality care Right to privacy

The totality of all policies , infrastructures, facilities, equipments, products, human resources and services that address the health needs, problems and concerns of all people. Preventive health care. Major concern of government-owned health centers Preventive care- provided by both government and private hospitals

RA 7160( Local Government Code)

Aims to transform local government units into self-reliant communities and active partners in the attainment of national goals through a more responsive and accountable local government structure instituted through a system of decentralization.

1993
Department of Health Regional hospitals, Medical centers, Special and Specialty hospitals Provincial government All provincial, district and municipal hospitals Municipal government Rural Health Units and Barangay health Stations

Provincial Heath Board

Provincial Health Office

Provincial Hospital

District Hospital

Other Health and Medical Facilities

Municipal Health Office

Office of the Mayor

Municipal Health Board

Municipal Health Office

Rural Health Unit/ Health Center

Barangay Health Station

Mandated to propose annual budgetary allocations for the operation and maintenance of health facilities and services within the municipality, city or province.
Provincial level
Governor(chairman) Provincial Health Officer

City/Municipal level
Mayor (chair) Municipal Health Officer

(vice chair) Chairman of the Committee on Health of the Sanguniang panlalawigan DOH representative NGO representative

(vice chair) Chairman of the Committee on Health of the Sanguniang Bayan DOH representative NGO representative

The history of PHNsg in the Phil. is embedded in history of the DOH which was first established as the Department of Public Works, Education and Hygiene in 1898

1912
The Fajardo Act(Act no. 2156) created sanitary divisions The president of the Sanitary division took charge of 2-3 municipalities If there are no physicians available, male nurses perform the duties of the president

PGH under the Bureau of Health sent four nurses to

Cebu to take care of mothers and their babies St. Paus Hospital School of nursing in Intramuros assigned 2 nurses to do home visiting in Manila

1914
School nursing was rendered by a nurse employed

by the Bureau of Health in Tacloban, Leyte. Reorganization Act No. 2462 created the Office of General Inspection. Headed by a lady physician Dr. Rosario Pastor
The Office of District Nursing was organized under this office

2 graduate Filipino nurses, Mrs. Casilang Eustaquio

and Mrs. Matilde Azurin were employed for maternal and child health sanitation in Manila

1916-1918
Ms. Perlita Clark took charge of the public health

nursing work Staff was composed of 1 American nurse supervisor, 1 American dietician, 36 Filipino Nurses working in the provinces, 1 nurse and 1 dietician assigned in two sanitary divisions

1917
4 graduate nurses paid by the City of Manila were

employed to work in the City Schools Provinces were encouraged to employ a district nurse to carry out school services

1918
The office of Ms. Clark was abolished due to lack of funds

1919
The first Filipino nurse supervisor under the Bureau of Health, Ms. Carmen del Rosariowas appointed. She succeded ms. Mabel Dabbs She had a staff of 84 PHNs assigned in five health stations There was a gradual increase of public health nurses and expansion of services

1923
2 government Schools of Nursing were established: Zamboanga General Hospital SN and Baguio General Hospital SN- intended to train non-Christian women and prepare them to render service among their people

July 1, 1926
Ms. Carmen Leogardo resigned and Ms. Genara S. Manongdo, a ranking supervisor of the American Red Cross, Phil. Chapter was appointed

1927
The Office of District Nursing under the Office of

General Inspection, Phil. Helth Service was abolished and supplanted by the section of Public Health Nursing. Mrs. Genara de Guzmanacted as consultantto the Director of Health in nursing matters

1928
The first convention of nurses was held followed by

yearly conventions until the advent of WWII Pre-service training was initiated as a prerequisite for appointment

1930
The section of Public Health Nursing was converted

into Section of Nursing due to pressing need for guidance not only in public nursing service but also in hospital nursing and nursing education The Section of Nursing was transferred from the Office of General Services to the Division of Administration This office covered the supervision and guidance of nurses in the provincial hospitals and the two government SN

1933
Reorganization Act No. 4007 transferred the Division of Maternal and Child Health of he Office of Public Welfare Commission to the Bureau of Health.

Mrs. Soledad A. Buenafe, former Asst. Superintendent of the Public Welfare Commissionwas appointed as Asst. Chief Nurse of the section of Nursing, Bureau of Health

1941
Activities and personnel including 6 public health members of the Metropolitan Division, Bureau f Health were transferred to the new department. Dr. Mariano Icasiano became the first City Health Officer of Manila An Office of Nursing was organized with Mrs. Vicenta Ponce as Chief Nurse and Mrs. Rosario Ordiz as Asst. CN

Dec. 8, 1941
When WWII broke out, PHNs in Manila were

assigned to devastated areas to attend to the sick and the wounded

1942
A group of PHNs, physicians and administrators

from the Manila Health Department went to the internment camp in Capas, Tarlacto receove sick POW They were confined at San Lazaro Hospital and 68 NPHNs were assigned to help the hospital staff take care of them

July 1942
31 nurses who were taken POW y the Japanese army

and confine at the Bilibid Prison in Manila were released to the then Director of the Bureau of Health, Dr. Eusebio Aguilar Many PHNs joined the guerrillas

Feb 1946
Post war record of the BOH showed that there were308

PHNs and 38 supervisors compared to 556/38pre-war In the same year, Mrs. Genara de Guzman, Technical Asst. In Nursing of he DOH and concurrent Pres. Of the Filipino Nurses Assoc. Recommended the creation of a Nursing Office in the DOH

Oct. 7, 1947
Executive Order No. 94 reorganized government offices and created the Division of Nursing under the Office of the secretary of health It was implemented on Dec. 16, 1947. Mrs. Genara de Guzman was appointed as Chief of the Division, with 3 assts. Ms. Annie Sand for nursing education; Mrs. Magdalena Valenzuelafor PHNng and Mrs. Patrocinio Montellano for Staff Eduacation.

1948
The 1st training Center for Bureau of Health was

organized in cooperation with the Pasay City Health Department. It was housed at the Tabon Health Center that was later renamed as Dona Martha Health Center.

1950
The Rural Health Demonstration and Training Center

was established by the DOH through the initiative of Dr. Hilario Lara, Dean, Institute of Hygiene, now College of Public Health, UP The WHO/UNICEF assisted project used health centers of the QC Health Department RHDTC was used as laboratory for the field experiences of graduate and basic student s in medicine, nursing, health education, nutrition, social work

1953
The Office of Health Education and Personnel Training(forerunner of Health Manpower Development and Training Service was established with Dr. Trinidad Gomez as Chief.

Phil. Congress approved Republic Act No. 1082 or the Rural Health Law. It created the 1st 81 RHUs. Each unit had a physician, a PHN, a MW, a sanitary inspector and a clerk driver. The UNICEF provided transportation.

1957
Republic Act 1891 was approved amending Sections 2,3,4,7 and 8 of RA 1082 Strengthening Health and Dental Services in the Rural Areas and Providing Funds thereto.

1958-1965
RA 977 passed in congress in 1954 was implemented. This abolished the Division of Nursing.

 He Reorganization Act with implementing details

embodied in EO 288, series of 1959 de-centralized and integrated health services. It created 8 Regional Health Offices in the country which later increased to 7 and eventually 17.

1967
In the Bureau of Disease Control, Mrs. Zenaida

Panlilio-Niscewas appointed as Nursing Program Supervisor and served as consultant on the nursing aspects of the 5 special diseases: TB, Leprosy, Veneral dses, Ca, Filariasis; and Mental Health.

Nov. 1971
Mrs. Josefina Mendoza Supervising Nurse Instructor, Office of Health Education and Personnel Training succeeded Annie Sand as Nursing Consultant

1974
He Project Management Staff was organized as part of Population Loan II of the Phil. Government with Dr, Francisco Aguilar as Project Manager

1975
As a result of recruiting of the health care delivery system based on findings of the Operations Research conducted in the province of Rizal, the functions of the health team members ( MHO, PHN, RHM and RSI) were defined. The roles of PHN and RHMwere expanded

1976-1986
The Nursing Consultant and Nursing Program Supervisor of the Secretary of Healthwere involved in the Rural Health Practice Programs which required medical and nursing graduates to serve for two months of the rural areas of the countrybefore their licenses could be issued by the PRC

1986
The reorganization of the DOH during this period placed the position of nursing consultant at the Bureau of Health and Medical Services. It was later abolished when Mrs. Mendoza resigned. The nursing positions at the Central Office were at the Nat. Family Planning Service

1987-1989
EO 119 reorganized the DOH and created several offices and services w/in the department

1990-1992
He number of positions of Nusing Program Supervisors (Nurse IV)was increased as there where 2 or more appointed in each service. Maternal and Child Health Services, EPI, Control of Diarrheal Dse, Control of Acute Resp infxn, NCDCS, CDCS)

Jan 1999
Department Order No. 29 designated Mrs. Nelia Hizon, Nurse IV, then President of the Natl. League of Govt. Nurses, as Nursing Adviser. Matters regarding nurse and nursing are referred to her

May 24, 1999

EO 102 was signed by Pres. Joseph Estrada, redirecting the functions and operations of the DOH

2006-2006
The development of the Rationalization Plan to streamline the bureaucracy further was started and is in the last stages of finalization